Two levels of intervention in low-income women with depressive symptoms: compliance and programme assessment

AIMS

This study reports on the evaluation of a brief group intervention for women of limited means with depressive symptoms.

METHOD

A comparison design was used with pre-, post- and four-month follow-up assessments for 93 women in the group intervention condition who were given six two-hour sessions of psycho-educational intervention, and 42 women in a minimum individual condition who received a 20-minute explanation in addition to the educational material, which yielded the following results.

RESULTS

Both conditions were effective in motivating participants to engage in self-help activities (making time for themselves every week, using writing as a means of sorting out problems, talking to someone about their problems and carrying out the reflection and cognitive behavioural exercises) and to seek further professional help when necessary. The intervention condition was more positively evaluated since participants regarded it as having a greater influence on their life and problems. Influence was related to better understanding and coping with problems, mood improvement, changes in the way they thought about things, knowing themselves better and being more accepting of themselves.

CONCLUSIONS

The results suggest that both interventions tackle important issues related to depression in women but further data are needed for a better understanding of this relationship.

Phase III randomized pilot study comparing interferon α- 2b in combination with radiation therapy versus radiation therapy alone in patients with stage III-B carcinoma of the cervix

This randomized pilot study was designed to determine whether the addition of interferon α-2b to standard radiation therapy offered an advantage in loco-regional control and survival over radiation therapy alone in a homogeneous group of patients with stage IIIB carcinoma of the cervix. Thirty-six patients were treated with a combination of interferon α-2b plus radiation therapy, and 38 patients were treated with radiation therapy alone. Patients with evidence of ureteral obstruction were excluded from the study. Evaluation of loco-regional response was determined by pelvic examination, cervical cytology, biopsies and CT scans when indicated. Survival time was measured from initiation of treatment to date of death or last follow-up. Patient characteristics were comparable between both study arms. The objective complete response rate was 67% in the combined therapy group and 55% in the radiation alone group (P = 0.454). With a median follow-up of 17 months for all patients and 31 months for live patients, 50% of the combined group survived vs. 39.5% of the radiation alone group (P = 0.424). We conclude that the addition of interferon α-2b to standard radiation therapy did not significantly improve loco-regional response or survival, although such a trend was noted. We encourage the design of a larger randomized study with sufficient power to detect meaningful differences to prove whether the tendency observed in the present investigation holds any promise to improve the outcome of these patients.

An increased expression of nucleolin is associated with a physiological nucleolar segregation

Nucleolar segregation is the most striking cellular phenotypic feature of cold-acclimatized carp and depicts the cyclical reprogramming that the physiology of the fish undergoes between summer and winter, where a clear differential expression of some nucleolar related genes occurs. We characterized carp nucleolin, a nucleolar protein involved in multiple steps of ribosome biogenesis, and evaluated its expression upon fish acclimatization. We show that the carp cDNA deduced amino acid sequence exhibits the same tripartite structural organization found in other species. Nevertheless, we observed that nucleolin mRNA expression was strongly induced in the cold-adapted carp as was the nuclear protein content, assessed by immunocytochemistry in liver sections. The physiological up-regulation of nucleolin in the cold-acclimatized carp, where rRNA transcription and processing are depressed concomitantly with the nucleolus segregation, is consistent with the notion that nucleolin plays a fundamental role in repressing rRNA synthesis.

[Physical sports activity in a representative sample of the population of Región de Murcia, Spain]

OBJECTIVE

To estimate the prevalence of intense physical activity according to age and sex in the region of Murcia, Spain, and to analyze its association with major demographic and socioeconomic determinants and other cardiovascular risk factors.

METHODS

Survey of a representative sample of the population aged between 18 and 65 years from Murcia was performed using multistage random sampling with definition of the sample quotas. A total of 3091 individuals were surveyed. The frequency and duration of intense physical sports activity during the two weeks prior to the survey was obtained using a validated questionnaire. Information was also collected on socioeconomic variables, smoking, blood pressure, weight and height and a blood test was performed to determine plasma lipids. Intense or vigorous physical activity (> or = 6 Metabolic Equivalents [MET]) was measured in kcal/day and reduced to hours/week to give three categories: no vigorous physical activity, less than 2 hours/week, and 2 hours/week or more.

RESULTS

Overall, 17.8% (95% CI: 16.6-19.0) of the adult population of the region of Murcia performed intense physical activity for > or = 2 hours/week. The figures were twice as high in men (23.1%; 95% CI: 21.0-25.2) than in women (12.5%; 95% CI: 10.9-14.1). In the logistic regression analysis, a higher frequency of intense physical activity was associated with age, level of education and employment situation. In men it was also associated with occupation and residence in urban areas.

CONCLUSIONS

During the study period, one in five adults in the region of Murcia took intense physical sports activity with a frequency and duration that were compatible with the prevention of episodes of coronary ischemia.

Outcome results of two levels of intervention in low-income women with depressive symptoms

The effectiveness of 2 levels of intervention in reducing depressive symptoms in women was evaluated using a comparison design for a group condition (6 2-hr weekly sessions) and a minimum individual condition (20-min individual orientation plus psychoeducational material) with pretreatment, posttreatment, and follow-up assessments (93 in the group and 42 in the individual condition). A multivariate analysis of variance showed significant differences, in the expected direction, within the groups but not between conditions. Further comparisons showed a significant reduction from pretreatment to posttreatment and from pretreatment to follow-up assessment. Similar results were found for criteria-related variables (somatic and anxiety symptoms); an increase in self-esteem was observed as well.

Soy product consumption in 10 European countries: the European Prospective Investigation into Cancer and Nutrition (EPIC) study

OBJECTIVE

The aim of this study was to describe the variation of soy product intake in 10 European countries by using a standardised reference dietary method. A subsidiary aim was to characterise the pattern of soy consumption among a sub-group of participants with a habitual health-conscious lifestyle (HHL), i.e. non-meat eaters who are fish eaters, vegetarians and vegans.

DESIGN

A 24-hour dietary recall interview (24-HDR) was conducted among a sample (5-12%) of all cohorts in the European Prospective Investigation into Cancer and Nutrition (EPIC). Study participants totalled 35 955 after exclusion of subjects younger than 35 or older than 74 years of age. Soy products were subdivided into seven sub-groups by similarity. Distribution of consumption and crude and adjusted means of intake were computed per soy product group across countries. Intake of soy products was also investigated among participants with an HHL.

RESULTS

In total, 195 men and 486 women reported consuming soy products in the 24-HDR interview. Although soy product intake was generally low across all countries, the highest intake level was observed in the UK, due to over-sampling of a large number of participants with an HHL. The most frequently consumed soy foods were dairy substitutes in the UK and France and beans and sprouts among mid-European countries. For both genders, the sub-group of soy dairy substitutes was consumed in the highest quantities (1.2 g day-1 for men; 1.9 g day-1 for women). Participants with an HHL differed substantially from others with regard to demographic, anthropometric and nutritional factors. They consumed higher quantities of almost all soy product groups.

CONCLUSIONS

Consumption of soy products is low in centres in Western Europe. Soy dairy substitutes are most frequently consumed. Participants with an HHL form a distinct sub-group with higher consumptions of fruit, vegetables, legumes, cereals and soy products compared with the other participants.

Consumption of vegetables, fruit and other plant foods in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohorts from 10 European countries

OBJECTIVE

To describe and compare the consumption of the main groups and sub-groups of vegetables and fruits (V&F) in men and women from the centres participating in the European Prospective Investigation into Cancer and Nutrition (EPIC).

DESIGN

Cross-sectional analysis. Dietary intake was assessed by means of a 24-hour dietary recall using computerised interview software and standardised procedures. Crude and adjusted means were computed for the main groups and sub-groups of V&F by centre, separately for men and women. Adjusted means by season, day of the week and age were estimated using weights and covariance analysis.

SETTING

Twenty-seven centres in 10 European countries participating in the EPIC project.

SUBJECTS

In total, 35 955 subjects (13 031 men and 22 924 women), aged 35-74 years, randomly selected from each EPIC cohort.

RESULTS

The centres from southern countries had the highest consumption of V&F, while the lowest intake was seen in The Netherlands and Scandinavia for both genders. These differences were more evident for fruits, particularly citrus. However, slightly different patterns arose for some sub-groups of vegetables, such as root vegetables and cabbage. Adjustment for body mass index, physical activity, smoking habits and education did not substantially modify the mean intakes of vegetables and fruits.

CONCLUSIONS

Total vegetable and fruit intake follows a south-north gradient in both genders, whereas for several sub-groups of vegetables a different geographic distribution exists. Differences in mean intake of V&F by centre were not explained by lifestyle factors associated with V&F intake.

Vascular endothelial growth factor plasma levels in patients with systemic lupus erythematosus and primary antiphospholipid syndrome

The objective of this study was to assess the possible role of vascular endothelial growth factor (VEGF) in the pathogenesis of systemic lupus erythematosus (SLE) and primary antiphospholipid syndrome (PAPS). We studied 28 patients with SLE, 10 patients with PAPS, and 24 healthy controls. VEGF plasma levels were measured by ELISA. Immunolocalization of VEGF was done in renal tissue from SLE patients and cadaveric controls. Our results showed that VEGF plasma levels were increased in SLE patients compared with PAPS and controls. The correlation between clinical manifestations and VEGF levels revealed that SLE patients with renal failure had significantly increased plasma VEGF levels (134.1 + 91.0 pg/ml) compared with SLE patients with normal renal function (42.9 + 19.0 pg/ml), PAPS patients (41.9 + 26.6 pg/ml), and controls (36.2 + 27.0 pg/ml; P < 0.01). Immunostaining showed a strong expression of VEGF in SLE renal tissue samples. Our preliminary results indicate that VEGF is increased in plasma from patients with lupus nephritis and a moderate degree of renal failure and is overexpressed in renal tissue from these patients.

A large outbreak of Shigella sonnei gastroenteritis associated with consumption of fresh pasteurised milk cheese

A large outbreak of Shigella sonnei gastroenteritis occurred in Murcia Region (Southeast Spain) in the winter of 1995-1996. More than 200 people were affected. Epidemiological investigations implicated a regionally manufactured fresh pasteurised milk cheese as the vehicle of infection. A case-control study showed a statistically significant association between the illness and consumption of the suspect cheese. The dispersed sale of the cheese resulted in a regional dissemination of the organism and people were affected in eight townships. Research suggested that an infected foodhandler at the cheese factory might have been the source of contamination and that the processing method might have allowed cross-contamination to occur. This study emphasises the importance of increasing the control of strict hygiene during the processing of fresh cheese, since legislation does not forbid direct contact by hand that could result in contamination of cheese even when the milk pasteurisation process was correctly performed.

[Sociodemographic differences in adherence to the Mediterranean dietary pattern in Spanish populations]

OBJECTIVES

Lower social classes tend to eat a less healthy diet. The aim of this study was to compare adherence to the Mediterranean dietary pattern among different demographic and social groups in the adult population.

METHODS

A cross-sectional study was performed in southern and northern regions of Spain in healthy volunteers (15,634 men and 25,812 women), aged 29-69 years, who were members of the European Prospective Investigation on Cancer cohort in Spain. Nine groups of food were included in the definition of the Mediterranean diet: vegetables and garden products, fruits, pulses, cereals, red meat, fish, olive oil, milk and milk products, and wine. Two techniques were used in the analysis: comparison of the mean daily intake of each group and calculation of an overall score for all the foods according to educational level and original social class.

RESULTS

Groups with the lowest educational levels consumed more cereals and pulses and lower quantities of vegetables, olive oil (women), milk and milk products (men). Wine consumption was positively associated with education in women and was negatively associated in men. Calculation of a score to measure overall adherence to the Mediterranean dietary pattern eliminated differences according to each food category. No variations were found according to educational level, but small differences were found in original social class. The adherence score was lowest in young adults and women and was slightly higher in the south than in the north of Spain.

CONCLUSIONS

The results suggest that the Mediterranean dietary pattern is fairly uniform, at least in the adult population of the regions included in this study.

Tuberculosis in Spain: epidemiological pattern and clinical practice

SETTING

Thirteen Autonomous Regions in Spain.

OBJECTIVE

To study the incidence of all forms of tuberculosis (TB) and investigate clinical practice in TB.

DESIGN

Cases of all forms of tuberculosis diagnosed in the study setting from May 1986 to April 1997 were identified though active search of different databases. Clinical and epidemiological information on cases was collected from clinical records or by interview with physicians.

RESULTS

The overall incidence of all forms of tuberculosis was 38.5/100,000 and the incidence of smear-positive disease was 13.83/100,000. Most cases (97.1%) were Spanish nationals, with rates higher in men than in women (52.7/100,000 vs. 24.87/100,000) and in groups aged 25-34 and 75 years and over (61.35/100,000 and 59.35/100,000, respectively). Disseminated forms were frequent (6.6%), and the most common risk factor was human immunodeficiency virus (HIV) infection (17.7% of cases). Hospitalisation was common (71.6%). Microbiological confirmation of diagnosis was sought for 87.7% of the cases (91.8% of pulmonary vs. 75.5% of extra-pulmonary cases), and 65.2% were culture-positive (73.8% of pulmonary vs. 39.7% of extra-pulmonary cases). HIV-infected patients were treated in almost equal proportions with three or four drugs (49.7% and 48.2%, respectively), while HIV-negative cases or those whose HIV status was unknown were usually treated with three drugs.

CONCLUSION

The epidemiological pattern of TB in Spain is different to other industrialised countries in the age distribution of cases and the proportions of foreigners and cases with HIV infection. Microbiological confirmation of diagnosis is more common in pulmonary than in extra-pulmonary disease, and treatment with four drugs more frequent in HIV-positive cases.

The tree Cedrela odorata (Meliaceae): a morphologically subdivided species in Costa Rica

In Latin America. Cedrela odorata is a wide ranging species that occurs in several environments, where it shows significant morphological variation. A common garden experiment was established with seedlings from 63 families of ten populations from two habitat types (mesic and dry), distributed throughout Costa Rica, to examine the relationships between quantitative variation and site of population origin. Seedlings from dry areas tended to be distinct from those from mesic areas, with climatic grouping of provenance explaining a mean of 52% of the total variance and 80% of the genetic variance. Cluster analysis for seedling traits showed two natural groupings of families, which corresponded for the most part with the regional population groupings into mesic (Atlantic and South Pacific) and dry (North Pacific) groups. Cluster analysis based on seed weight and size also separated populations into mesic and dry climatic groups. Seeds from populations in dry areas were 43% heavier, and seedlings were 61% taller, 117% greater in diameter, and with leaflets 39% longer and 81% wider. These differences may be related to fast growth in the dry zone for taking advantage of early life cycle moisture availability. These findings may indicate incipient speciation in C. odorata in Costa Rica. Evaluation of reproductive isolating mechanisms between populations from the mesic and dry zones, and of clines at potential zones of hybridization would assist in testing a speciation hypothesis.

Molecular heterogeneity of myophosphorylase deficiency (McArdle's disease): a genotype-phenotype correlation study

We report on 54 Spanish patients with McArdle's disease from 40 unrelated families. Molecular analysis revealed that the most common R49X mutation was present in 70% of patients and 55% of alleles. The G204S mutation was less frequent and found in 14.8% of patients and 9% of mutant alleles. The W797R mutation was observed in 16.5% of patients, accounting for 13.7% of mutant alleles. Moreover, 78% of mutant alleles among Spanish patients can be identified by using polymerase chain reaction-restriction fragment length polymorphism analysis for the R49X, G204S, and W797R mutations, which makes noninvasive diagnosis possible through molecular genetic analysis of blood DNA. Six novel mutations were found. Three were missense mutations, E348K, R601W, and A703V; two nonsense mutations, E124X and Q754X; and one single base pair deletion, 533 delA. No clear genotype-phenotype correlation emerges from our study. Most of the mutations of uncharged and solvent inaccessible residues and the truncations must disrupt the basic structure of the protein. The mutations of charged residues would be expected to interfere with internal hydrogen bonding networks, introducing severe incompatible partnering that is caused by poor packing or electrostatic repulsions.

Is there a different dietetic pattern depending on self-knowledge of high blood pressure?

This cross-sectional study describes the dietary pattern seen at recruitment in a large Spanish cohort comprising 41,451 people (aged 30-69 years) according to high blood-pressure status. We provide information on adjusted mean daily intake of foods and nutrients, by means of a dietary history, from those people self-reported as having high blood pressure as well as from those self-reported as normotensive but having, after actual blood-pressure measurement, systolic or diastolic blood pressures of > or = 160/95 mmHg. Although with small differences in mean intake people who self-reported high blood pressure have a higher consumption of potatoes, vegetables, vitamin C and E; furthermore, men reported an increased intake of fruit, meat, fish, proteins, dietary fibre, beta-carotene and alcohol, and women tended to consume less alcohol, lipids and cholesterol but more proteins, carbohydrates and dietary fibre. Almost no differences are found in fatty acid intake. This pattern is reversed among those self-reported as normotensive but with high blood pressure after actual measurement. We conclude that in this large prospective cohort, awareness or not of having high blood pressure at recruitment is associated with a differential dietary pattern.

Extremely high prevalence of overweight and obesity in Murcia, a Mediterranean region in south-east Spain

OBJECTIVE

To estimate the prevalence of obesity in the Murcia Region according to age and sex, and to analyse how obesity is related to demographic and socio-economic determinants and to other cardiovascular risk factors of interest to the community.

DESIGN

Survey on a representative population sample using multi-stage random sampling with definition of the sample quotas.

SUBJECTS

A total of 3091 persons aged 18-65 y residing in the Murcia Region.

MEASUREMENTS

: The following data were collected: socio-economic data; tobacco smoking; recent physical activity; blood pressure; weight; height; and blood analysis to determine plasma lipids. Obesity was defined by body mass index (BMI)> or =30. Intense or vigorous physical activity (VPA> or =6 equivalents to baseline metabolic rate or METs) was measured in kilocalories per day and reduced to hours per week.

RESULTS

In all, 20.5% of the adult population of the Murcia Region is obese, and 40.9% is overweight. In the logistic regression analysis, obesity in men is associated with age and level of education. In women it is associated with age, level of education, living in a non-urban area and being a housewife. When adjusted for socio-economic variables and for other cardiovascular risk factors the effect of age and level of education disappears in men and it is directly associated with hypertension and hypertriglyceridaemia and inversely related to more than 2 h VPA per week. Obesity in women is associated positively with age, hypertension, hypertriglyceridaemia and little VPA, and inversely with level of education.

CONCLUSIONS

In the Murcia Region 61.4% of the adult population presents with some form of excess weight. The prevalence of obesity (BMI> or =30) is greater in women (23.7%; CI 95% 19.7-27.7) than in men (17.3%; CI 95% 15.3-19.3). The widespread nature of this factor makes it a mass problem that requires generalised interventions to prevent it.

[Usefulness of the statistical bulletin of deaths to identify extrahospital deaths in the context of a myocardial infarction population registry]

INTRODUCTION AND AIMS

This paper aimed to study the usefulness of the Statistical Bulletin of Deaths (SBD) for identifying extrahospital deaths due to acute coronary ischaemia, and to determine the most efficient strategy in the selection of death causes that appear in the SBD, which are the most efficient for the identification.

METHODS

Those extrahospital deaths, which, among the causes of death, recorded a diagnostic code indicating that they might have been caused by coronary ischaemia, were included. To study the usefulness of the death certificate we calculated the sensitivity and the positive predictive value of cardiac ischaemia. To determine the most efficient strategy for selecting causes of death we compared two selection strategies: the first, using only the basic cause of death; and the second using all the causes appearing in the SBD.

RESULTS

Of the 395 SBD selected, 161 were classed as acute heart attacks. In those SBD in which cardiac ischaemic disease was given as the basic cause of death, we obtained a sensitivity of 82.6% (CI 95%: 75.9-88.1) and a positive predictive value of 72.7% (CI 95%: 65.6-79). The most efficient strategy in SBD selection proved to be the investigation of death certificates in which cardiac ischaemia appeared as one of all the causes of death, and death certificates in which the basic cause of death was coded as diabetes mellitus, essential arterial hypertension, hypertensive heart disease, cardiac dysrhythmia, and cardiac insufficiency.

CONCLUSIONS

The information provided by death certificates for extrahospital deaths due to coronary ischaemia is reliable. A sensitive and efficient SBD selection strategy is proposed for the detection of cases.

Late-onset metachromatic leukodystrophy clinically presenting as isolated peripheral neuropathy: compound heterozygosity for the IVS2+1G-->A mutation and a newly identified missense mutation (Thr408Ile) in a Spanish family

We report the case of a 50-year-old woman and her 32-year-old daughter, both of whom are affected with adult-onset metachromatic leukodystrophy (MLD) clinically presenting as peripheral neuropathy. Arylsulfatase A (ARSA) activities were markedly reduced, and electrophysiology showed a severe demyelinating neuropathy with features of chronic acquired demyelinating polyneuropathy. Molecular genetic studies of the family revealed that the proband and her affected daughter are compound heterozygotes for the common IVS2+ 1G-->A mutation and a newly identified missense mutation, Thr408Ile. This case indicates that adult metachromatic leukodystrophy should be considered in adult patients with demyelinating peripheral neuropathy of unknown etiology.

A new mtDNA mutation in the tRNA(Leu(UUR)) gene associated with ocular myopathy

We studied a patient with ptosis, ophthalmoparesis, and exercise intolerance who showed in her muscle biopsy ragged-red fibers and combined defects of the complexes I and IV of the mitochondrial respiratory chain. Molecular analysis revealed a T3273C transition in the mitochondrial DNA tRNA(Leu(UUR)) gene. The mutation was heteroplasmic and very abundant in muscle from the proposita, less abundant in her other tissues studied, and still less abundant in blood from her maternal relatives. Single muscle fiber analysis showed significantly higher levels of mutant genomes in ragged-red fibers than in normal fibers. The T3273C mutation affects a strictly conserved base pair in the anticodon stem and was not found in controls, thus satisfying the accepted criteria for pathogenicity.

Major histocompatibility complex and tumor necrosis factor-alpha polymorphisms in pigeon breeder's disease

Pigeon breeders disease (PBD) is caused by the exposure of a susceptible host to avian antigens. However, genetic factors determining individual predisposition are unknown. In this work, polymorphisms of the major histocompatibility complex (MHC) class II alleles and tumor necrosis factor alpha (TNF-alpha) promoter were evaluated in 44 patients with PBD, 99 healthy unrelated controls (HC), and 50 exposed but asymptomatic subjects (EAS). MHC typing was performed by PCR-specific sequence oligonucleotide analysis, and TNF-alpha polymorphism at -238 and -308 positions by amplification refractory mutation system-PCR. PBD patients showed a significant increase of the alleles HLA-DRB1*1305 (p < 0.001, OR = 15.4, 95% CI = 3.18-102.6 [HC], and OR = 17.05, 95% CI = 2.25-357.8 [EAS]) and HLA-DQB1*0501 (p < 0.05, OR = 2.93, 95% CI = 1.21-7.15 [HC], and OR = 2.96, 95% CI = 1.0-9.14 [EAS]). A decrease of HLA-DRB1*0802 was also noticed in patients when compared with both control groups (p < 0.05). Haplotype analysis revealed an increase of DRB1*1305-DQB1*0301 and a decrease of DRB1*0802-DQB1*0402. PBD patients had an increased frequency of TNF-2(-)(308) compared with both control groups (p < 0.05). Patients exhibiting the TNF-2(-)(308) allele were younger (33.9 +/- 14.6 versus 44.2 +/- 10.4 yr; p < 0.05), and displayed more lymphocytes in their bronchoalveolar lavages (88.0 +/- 12.1 versus 68.9 +/- 17.2; p < 0.05). These results suggest that genetic factors located within the MHC region contribute to the development of PBD.